59 year old Male
History of Present Illness (HPI):
- Morbidly obese patient: BMI = 61
- Hx of COPD, possible obstructive sleep apnea, systemic hypertension, hyperlipidemia.
- Presents with severe substernal chest pain.
- ECG revealed sinus rhythm with ST elevations in leads 2, 3 and aVF, with QS complexes in same. ST depression noted in leads 1 and aVL.
- Acute coronary syndrome diagnosed.
- Emergency cardiac catheterization revealed:
- Right Coronary Artery: 100% occlusion; dominant vessel.
- Left Main: Normal.
- Left Anterior Descending: 30% occlusion proximal portion.
- Left Circumflex Artery: Normal.
- Ramus Intermedus: 60% occlusion at origin.
- Left Ventricle: 45-50% ejection fraction (EF).